Agp Expression of Interest Form

7/27/2019 Agp Expression of Interest Form

1/5

Australian Growth Partnerships Program | EOI form | 2011 1.1 Page 1 of 5

Expression of Interest form

CSIRO Australian Growth Partnerships Program

Expression of Interest (EOI) form

1 Date of EOI:

2 Full Name of the entity applying (the Applicant)

& Major Shareholders:

3 ABN and/or CAN:

4 Applicants Business Address:

5 Applicants Postal Address:

6 Applicants Registered Office Address:

7 Name of Principal Contact for this EOI:

8 Phone (mobile):

9 Phone (office):

10 Email address:

11 How many employees does the Applicant have?

12 How long has the Applicant been in its current

business?

13 Specify the Applicants Annual Turnover forat

least the last 5 years.

14 Identify the Applicants basic corporate

structure, e.g. Private / Public / Joint Venture /

Trust etc.

15 Provide brief biographical data on each of the

senior management and Directors of the Boardwith details of previous grants secured (as

applicable).

16 Describe the Applicants Principal Business.

17 What proposed technological enhancement,

innovation or R&D program do you propose the

AGP investment be applied to?


2/5

EOI form continued


Expression of Interest (EOI) form

18 Describe how the proposed technological

enhancement, innovation or R&D program

would impact on the Applicants commercialsuccess.

If applicable, in the response please comment

on issues such as:

Anticipated increase in

competitiveness and/or resulting

change in market share over time.

The anticipated improvement on the

margin that might be gained.

Changes to the level of export

earnings.

Changes in Applicant employment

levels.

How long after a successful R&D

program before the Company expects

to derive an economic benefit from the

technological enhancement, innovation

or R&D program?

19 How would your proposed technological

enhancement, innovation or R&D program alignwith our Flagship Program?

20 Does the Applicant have a track record of

commercialisation technology based

innovations? If yes, provide details of the above

and contact person details?

21 Has the Applicant worked with CSIRO on a

project related to technology which is the

subject of this application? If yes, please

provide details of the above in addition to the

contact persons details.

22 Does the Applicant have any capacity to co-

invest with CSIRO on the program being

contemplated? If so please provide indicative

range.

23 Have you read and understood the Terms and

Conditions of this Expression of Interest (EOI)?

Yes No


3/5

EOI form continued


Signed and dated by the Applicant:

_____________________________________ _____________________________________

Signed and dated by the Director or duly Signature of the Director / Witness

Authorised Representative

_____________________________________ ______________________________________

Print name Print name

Please post this EOI form to:

AGP CSIRO

PO Box 93

North Ryde NSW 1670

Please email a Microsoft Word version of this EOI form to:

[email protected]
mailto:[email protected]:[email protected]:[email protected]


4/5

EOI form continued


Terms and conditions associated with submitting the EOI form

By completing and submitting an EOI, the Applicant agrees to the following terms and conditions:

1. General

1.1. CSIRO may exclude the Applicant from further consideration and evaluation if CSIRO

considers, at any time and in its absolute discretion that the Applicant is not suitable for

funding by CSIRO.

1.2. CSIRO may conduct reference checks, including site visits on the Applicant and its

officers (all personal information collected will be treated in accordance with CSIROs

privacy statement).

1.3. CSIRO may request further information from the Applicant during the selection process

and will, as appropriate, engage in discussions or negotiations with any Applicant for the

purpose of clarifying or improving its response. CSIRO may, in its absolute discretion,

conduct simultaneous discussions with other applicants to clarify or improve proposals.

1.4. CSIROs AGP funding decisions will be in its absolute discretion and subject to CSIRO

internal approval processes and full execution of final transaction documents. No

binding legal relationship will arise from the AGP funding process until all transaction

documents are signed by all parties.

1.5. The Applicant must not engage in any behaviour which is anticompetitive, misleading or

deceptive or attempt to improperly influence any officer, employee or agent of CSIRO in

connection with AGP.

1.6. CSIRO is not responsible for any loss, damage, costs or expenses incurred by the

Applicants or any third party as a result of the Applicant submitting this EOI or

participating in the AGP funding process.

2. Use of EOI and other submitted material

2.1. The Applicants EOI response will be as part of the assessment of the Applicants

suitability for funding by CSIRO through AGP. The Applicant warrants that all

information it provides to CSIRO in the EOI is true and correct.

2.2. Subject to 3.1 and 3.2 below, all material submitted by the Applicant, including this EOI

becomes the property of CSIRO (Material). The Applicant grants to CSIRO a non-

exclusive, worldwide, royalty-free licence to copy, use, modify and disclose the copyright

works in the Material, for the purpose of evaluating the Applicants response and

negotiating final transaction documents if the Application is selected.


5/5

EOI form continued


3. Confidentiality

3.1. Subject to 3.2, CSIRO will treat as confidential, any information provided by the

Applicant to CSIRO which the Applicant specifies in writing is confidential (excluding

information which (a) was created by or for CSIRO independently of the information

provided to it by the Applicant; (b) is rightfully known by CSIRO as a consequence of the

information being disclosed from an independent source without any limitation on its useor disclosure; (c) in the public domain (otherwise than a result of a breach of these

terms); or (d) required to be disclosed by law).

3.2. CSIRO and its advisors may use the Applicants confidential information for the

purposes of administering, managing and reporting on AGP and determining suitability

of the Applicant for AGP funding, including the negotiation and preparation of final

transaction documents to effect AGP funding.

3.3. The Applicant must treat as confidential, any information and documents provided by

CSIRO to the Applicant including all information and documents regarding CSIROs

business, technology, operational and financial arrangements. If the Applicant is short-

listed for advanced due diligence, CSIRO will require the Applicant to enter into a non-

disclosure agreement before the Applicant can enter into further discussions with

CSIRO.

END

Documents

Agp Expression of Interest Form